What should I do if my eyelid still does not fold even after double eyelid surgery? (Photo)

I am a cosmetic oculofacial plastic surgeon who specializes in cosmetic
surgery of the eyes. Asian eyelid surgery is an area where I focus my practice
on among many other specialty areas. With the photos you submitted, it doesn’t
appear that there is any significant ptosis on the side that has not developed
a crease. When you do incisional or non-incisional Asian eyelid surgery, it is
critical to create some type of connection between the skin and the levator
muscle that lifts the eyelid. Occasionally, when this area heals, even when you
do anchoring of the skin to the levator muscle, the skin can pull away and the
crease can become less defined.



In my practice, I always have to individualize when patients complain
about things like this. In general, it’s not about removing more skin when someone
is relatively young. Since you’ve already had some skin removed, it’s about
restoring the connection. I would try to do a revision by just doing the
non-incisional approach. This is through openings in the eyelid skin and trying
to anchor and restore a connection to the underlying muscle. There are many
factors that can cause what you’re going through and anybody who does Asian
eyelid surgery would certainly be familiar with this. It’s just a matter of
creating that connection, so once it's done well so the crease folds in, it
tends to hold up and last a long time.



It’s important that you discuss this issue with your doctor and review
your pre-operative photos whether or not there is a change. Maybe your doctor
feels that your eyelid is slightly lower than it was before. Since there were
no previous photos submitted with your question, I can’t address that as a
change. It may be that your doctor is saying that you need a procedure like a
ptosis surgery because ptosis surgery also involves the levator muscle and so
there may be some misinterpretation. It is not uncommon for patients to walk
away and not fully understand what the doctor was trying to communicate.



As a suggestion, you may ask your doctor about this non-incisional
approach to try to restore the crease. A physical exam is critically important.
If your doctor feels that there may be some scar tissue that needs to be
addressed or there is something needs to be done, the doctor who did your
surgery knows your eyes and knows what they came across when they did your
surgery. Clearly, there is some indication for an enhancement to maximize
symmetry. It’s a matter of figuring out what is the best procedure for you. I
hope that was helpful, I wish you the best of luck, and thank you for your
question.



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Based on your photos, it does not appear that you have any ptosis that would need to be surgically addressed.  With Asian eyelid surgery, there is a non-trivial crease failure rate.  For suture techniques, this rate is a bit higher than incisional techniques.  An incisional revision surgery would be an option for you to create greater symmetry.  

The crease on your left upper eyelid (on the right of the photo) is lacking definition.  You may benefit from a revision on that side, to help improve your symmetry.  If you had the suture method of double eyelid surgery, I would opt for the incisional method the second time around.